Institute for Clinical Immunology and Transfusion Medicine, Justus-Liebig-University Giessen, Langhansstr. 7, 35392, Giessen, Germany.
German Center for feto-maternal Incompatibility, 35392, Giessen, Germany.
Arch Gynecol Obstet. 2020 Aug;302(2):355-363. doi: 10.1007/s00404-020-05618-y. Epub 2020 Jun 4.
In pregnant women with a history of fetal and neonatal alloimmune thrombocytopenia (FNAIT), prenatal intervention in subsequent pregnancies may be required to prevent fetal bleeding. Several invasive and non-invasive protocols have been published: amniocentesis for fetal genotyping, fetal blood sampling for the determination of fetal platelet count, intrauterine platelet transfusions, and weekly maternal i.v. immunoglobulin (IVIG) infusion with or without additional corticosteroid therapy. This is the first retrospective study that report the experience with a non-invasive protocol focused on side effects of maternal IVIG treatment and neonatal outcome.
Pregnant women with proven FNAIT in history and an antigen positive fetus were treated with IVIG (1 g/kg/bw) every week. To identify potential IVIG-related hemolytic reactions isoagglutinin titer of each IVIG lot and maternal blood count were controlled. IVIG-related side effects were prospectively documented and evaluated. Furthermore, ultrasound examination of the fetus was performed before starting IVIG administration and continued regularly during treatment. Outcome of the index and subsequent pregnancy was compared. Corresponding data of the newborns were analyzed simultaneously.
IVIG was started at 20 weeks of gestation (median). Compared to the index pregnancy, platelet counts of the newborns were higher in all cases. No intracranial hemorrhage occurred (Index pregnancies: 1 case). Platelet counts were 187 × 10/l (median, range 22-239, 95% CI) and one newborn had mild bleeding. No severe hemolytic reaction was observed and side effects were moderate.
Among pregnant women with FNAIT history, the use of non-invasive fetal risk determination and maternal IVIG resulted in favorite outcome of all newborns. Invasive diagnostic or therapeutic procedures in women with a history of FNAIT should be abandoned.
对于有胎儿和新生儿同种免疫性血小板减少症（FNAIT）病史的孕妇，可能需要在后续妊娠中进行产前干预以防止胎儿出血。已经发表了几种有创和无创方案：羊膜穿刺术进行胎儿基因分型、胎儿血液采样以确定胎儿血小板计数、宫内血小板输注以及每周静脉内免疫球蛋白（IVIG）输注，伴或不伴额外皮质类固醇治疗。这是第一项报告专注于 IVIG 治疗的母体副作用和新生儿结局的非侵入性方案经验的回顾性研究。
历史上证实有 FNAIT 的孕妇且胎儿抗原阳性，给予 IVIG（1g/kg/bw）每周一次。为了确定潜在的 IVIG 相关溶血性反应，控制每个 IVIG 批次的同种抗体滴度和母体血常规。前瞻性记录并评估 IVIG 相关副作用。此外，在开始 IVIG 给药前对胎儿进行超声检查，并在治疗过程中定期进行。比较指数妊娠和后续妊娠的结局。同时分析新生儿的对应数据。
IVIG 在 20 周妊娠（中位数）开始。与指数妊娠相比，所有情况下新生儿的血小板计数均升高。未发生颅内出血（指数妊娠：1 例）。血小板计数为 187×10/l（中位数，范围 22-239，95%CI），1 例新生儿有轻度出血。未观察到严重的溶血性反应，副作用为中度。
在有 FNAIT 病史的孕妇中，使用非侵入性胎儿风险确定和母体 IVIG 导致所有新生儿的结局均较好。对于有 FNAIT 病史的女性，应放弃有创诊断或治疗程序。
